Yugo Yamashita1, Ryuji Uozumi2, Yasuhiro Hamatani3, Masahiro Esato4, Yeong-Hwa Chun4, Hikari Tsuji5, Hiromichi Wada6, Koji Hasegawa6, Hisashi Ogawa7, Mitsuru Abe7, Satoshi Morita2, Masaharu Akao7. 1. Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine. 2. Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine. 3. Division of Heart Failure, National Cerebral and Cardiovascular Center. 4. Department of Arrhythmia, Ijinkai Takeda General Hospital. 5. Tsuji Clinic. 6. Division of Translational Research, National Hospital Organization Kyoto Medical Center. 7. Department of Cardiology, National Hospital Organization Kyoto Medical Center.
Abstract
BACKGROUND: The current status and outcomes of direct oral anticoagulant (DOAC) use have not been widely evaluated in unselected patients with atrial fibrillation (AF) in the real world.Methods and Results: The Fushimi AF Registry is a community-based prospective survey of AF patients who visited the participating medical institutions (n=80) in Fushimi, Kyoto, Japan. Follow-up data with oral anticoagulant (OAC) status were available for 3,731 patients by the end of November 2015. We evaluated OAC status and clinical outcomes according to OAC status. The number (incidence rate) of stroke/systemic embolism (SE) and major bleeding events during the median follow-up of 3.0 years was 224 (2.3%/year) and 177 (1.8%/year), respectively. After the release of DOAC, the prevalence of DOAC use increased gradually and steadily, and that of warfarin, DOAC and no OAC was 37%, 26% and 36%, respectively in 2015. On Cox proportional hazards modeling incorporating change in OAC status as a time-dependent covariate for stroke/SE and major bleeding events, use of DOAC compared with warfarin was not associated with stroke/SE events (HR, 0.95; 95% CI: 0.59-1.51, P=0.82) or major bleeding events (HR, 0.82; 95% CI: 0.50-1.36, P=0.45). CONCLUSIONS: In real-world clinical practice, there were no significant differences in stroke/SE events or major bleeding events for DOAC compared with warfarin in patients with AF.
BACKGROUND: The current status and outcomes of direct oral anticoagulant (DOAC) use have not been widely evaluated in unselected patients with atrial fibrillation (AF) in the real world.Methods and Results: The Fushimi AF Registry is a community-based prospective survey of AFpatients who visited the participating medical institutions (n=80) in Fushimi, Kyoto, Japan. Follow-up data with oral anticoagulant (OAC) status were available for 3,731 patients by the end of November 2015. We evaluated OAC status and clinical outcomes according to OAC status. The number (incidence rate) of stroke/systemic embolism (SE) and major bleeding events during the median follow-up of 3.0 years was 224 (2.3%/year) and 177 (1.8%/year), respectively. After the release of DOAC, the prevalence of DOAC use increased gradually and steadily, and that of warfarin, DOAC and no OAC was 37%, 26% and 36%, respectively in 2015. On Cox proportional hazards modeling incorporating change in OAC status as a time-dependent covariate for stroke/SE and major bleeding events, use of DOAC compared with warfarin was not associated with stroke/SE events (HR, 0.95; 95% CI: 0.59-1.51, P=0.82) or major bleeding events (HR, 0.82; 95% CI: 0.50-1.36, P=0.45). CONCLUSIONS: In real-world clinical practice, there were no significant differences in stroke/SE events or major bleeding events for DOAC compared with warfarin in patients with AF.
Entities:
Keywords:
Atrial fibrillation; Bleeding; Direct oral anticoagulant; Stroke
Authors: Annette von Drygalski; Vikas Bhat; Andrew J Gale; Patricia M Averell; Thomas J Cramer; Darlene J Elias; John H Griffin; Laurent O Mosnier Journal: Blood Adv Date: 2020-08-11